S T A L E V O - the easy levodopa

Helpful articles on aspects of living with PD

Brian Magennis is a Movement Disorders/Parkinson's Disease Nurse Specialist working in the Mater Misericordiae Hospital in Dublin. In this article he assesses the potential impact of "Stalevo", a new drug combination, now available in Ireland.

Orion Pharma, the manufacturers of Comtess (entacapone) in Ireland have launched a new drug treatment for Parkinson’s disease. Stalevo is a triple preparation drug made up of Levodopa, Carbidopa and Entacapone all in the one tablet.

Levodopa still remains the most effective treatment for Parkinson’s disease but there are some challenges associated with its long-term use. These challenges appear in the form of motor fluctuations – involuntary movements (dyskinesias), On/Offs and Wearing off. Undoubtedly these cause more distress for the person with Parkinson’s than the condition itself. Why or how the motor fluctuations occur has been a question that researchers have only recently established an answer to.

There are three main contributory factors –

  • the short half-life of levodopa,
  • the number of times a day it is taken and
  • the small amount of levodopa (10%) that eventually reaches the brain from taking one tablet.

The challenge to the Health Care Professionals is obtaining a continuous levodopa stimulation of the brain instead of a pulsatile stimulation.

It was with this challenge so clearly in my mind that I waited with a sense of anticipation at the recent Orion Symposium held at the 7th Congress of the European Federation of Neurological Societies in Helsinki on Sunday 31st August 2003. The meeting brought together five of the world’s leading Neurologists with a special interest in Parkinson’s Disease and Movement Disorders. In combination they detailed the exciting data from new clinical studies, together with their practical experiences of Stalevo (levodopa+carbidopa+entacapone). This to me has been waiting to happen for years - it is common sense.

Stalevo - a new levodopa

Stalevo is a new levodopa – the effect of each dose is extended and the delivery to the brain is smoother and more constant. Stalevo may sound a strange name but it is made up of two parts. Sta – coming from the word stable and levo- coming from the word levodopa. It will be available in the following doses:
  • Stalevo 50 – (levodopa 50mg, carbidopa 12.5mg, entacapone 200mg)
  • Stalevo 100 -(levodopa 100mg, carbidopa 25mg, entacapone 200mg)
  • Stalevo 150 – (levodopa 150mg, carbidopa 37.5mg, entacapone 200mg)

Practicalities of using Stalevo

The one question that sprang to my mind was: how difficult it will be to convert from a person’s present drug regime to this new product? Not difficult at all, it appears!

There will be two conversion scenarios:

  1. Patients currently on standard levodopa without Comtess (entacapone):-
    • It is recommended to switch to a corresponding dose of Stalevo – since the effect of levodopa is enhanced with this formulation, it may be possible to reduce the daily dose of levodopa.

  2. Patients currently on Sinemet or Madopar and Comtess (entacapone):-
    • It is recommended to switch to a corresponding dose of Stalevo, as follows:

      Current levodopa / carbidopa treatment:

      • ˝ Sinemet Plus with Comtess 200mg = Stalevo 50
      • Sinemet Plus with Comtess 200mg = Stalevo 100
      • 1˝ Sinemet Plus with Comtess 200mg = Stalevo 150

If you are taking Madopar instead of Sinemet, a switch to Stalevo is just same.

The maximum dose of Stalevo to be taken in one day is ten tablets and they should not be broken, chewed or crushed. A Stalevo tablet is red/brown in colour, slightly smaller in size than Comtess.

Stalevo has been well tolerated during the clinical trials. The side-effects: mainly some nausea, and if dyskinesia occurred, it could quite quickly be eliminated by tailoring down the dose of Stalevo. These trials have also shown that Stalevo is easier to use, easier to swallow, easier to tolerate, and easier to remember than taking Sinemet/Madopar with a separate Comtess tablet.

I wish Orion Pharma all the very best with this new exciting levodopa product and look forward to its availability in the Republic of Ireland.

Brian Magennis
Parkinson’s disease Nurse Specialist,
Dept. of Neurology,
The Mater Hospital, Dublin

Our thanks to Brian and to Orion Pharma for this article.